Study Notes: Corticosteroids (Anti-inflammatory Steroids)

Study Notes: Corticosteroids (Anti-inflammatory Steroids)

I. Introduction

• Corticosteroids = anti-inflammatory steroids.

• Two parts of the name:

  • Steroid → hormone.

  • Cortico → related to cortisol (natural stress hormone).

• Distinction: Not anabolic (muscle growth) steroids → these primarily reduce inflammation.

II. Cortisol & Corticosteroid Basics

• Cortisol is made via:

  • Hypothalamus → ACTH → adrenal glands → cortisol release.

• Negative feedback loop: High cortisol inhibits hypothalamus.

• Receptors:

  • Glucocorticoid receptor (main therapeutic target).

  • Mineralocorticoid receptor (electrolyte balance).

III. Glucocorticoid Effects (3 main pathways)

1. Anti-inflammatory

   • Inhibits mediators: phospholipase A₂, IL-6, TNF-α, etc.

   • ↓ Inflammation (skin, lungs, hives, etc.).

2. Immunosuppression

   • Inhibits T-cells & B-cells → ↓ immune response.

   • Useful in transplant patients & autoimmune diseases.

3. Metabolic (liver)

   • ↑ Glucose release (glycogen → glucose).

   • Stress response = more energy.

   • Watch for hyperglycemia in diabetics.

IV. Mineralocorticoid Effects

• Sodium & water retention.

• Potassium excretion.

• Maintains fluid/electrolyte balance.

• Clinical use: Addison’s disease, adrenal insufficiency.

V. Dosage Forms

• Topical: Creams/ointments (hydrocortisone).

• Oral: Prednisone, methylprednisolone (dose packs).

• Inhaled/Intranasal: Symbicort, Flonase (asthma, allergies).

• IV/Injectable: Dexamethasone (hospital setting).

• Naming clue: Ends in -isone or -asone.

VI. Clinical Uses

• Inflammation (skin irritation, tissue damage).

• Allergic reactions (hives, anaphylaxis).

• Asthma/COPD (inhaled steroids).

• Autoimmune diseases (Crohn’s, MS, lupus).

• Cancer therapy (part of regimens, premeds).

• Adrenal insufficiency (mineralocorticoid use).

VII. Dosing & Potency

• Hydrocortisone = baseline potency (1×).

• Prednisone ≈ 4× stronger.

• Methylprednisolone ≈ stronger still.

• Dexamethasone = 25–30× stronger.

• Relative potency + mineralocorticoid activity guide drug choice.

• Taper required if therapy > ~6–7 days to prevent adrenal crisis.

VIII. Side Effects

• Weight gain (reversible).

• Fat redistribution (Cushing’s syndrome, “moon face”).

• Edema (fluid buildup).

• Osteoporosis (long-term use).

• Altered mental status (mood/behavior changes).

• Hyperglycemia (liver glucose release).

• Hypertension.

• Peptic ulcers.

• Increased infection risk (immune suppression).

• Adrenal crisis (abrupt stop → life-threatening).

IX. Quiz

1. Well-known adverse effect of chronic systemic glucocorticoid use?
   → Osteoporosis.

2. Common sign of iatrogenic Cushing’s syndrome?
   → Moon face (fat redistribution).

3. Why taper after prolonged therapy?
   → Prevent adrenal crisis (due to HPA-axis suppression).

4. Bone-related preventive measure in long-term therapy?
   → Calcium + Vitamin D supplementation, consider bisphosphonates.